title: Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands.
abstract: OBJECTIVE
  Document progress in HIV-treatment in The Netherlands since 1996 by reviewing changing patterns of cART use and relating those to trends in patients' short-term clinical outcomes between 1996 and 2010.
  
  
  METHODS
  1996-2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were described: i) recovery of 150 CD4 cells/mm(3) within 12 months of starting cART; ii) achieving viral load (VL) suppression ≤1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment.
  
  
  RESULTS
  Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudine-based regimens with unboosted-PIs to tenofovir with either emtricitabine or lamivudine with NNRTIs. Mortality rates did not change significantly over time. VL suppression and CD4 recovery improved over time, and the incidence of switching due to virological failure and toxicity more than halved between 1996 and 2010. These effects appear to be related to the use of new regimens rather than improvements in clinical care.
  
  
  CONCLUSIONS
  The use of first-line cART in the Netherlands closely follows changes in guidelines, to the benefit of patients. While there was no significant improvement in mortality, newer drugs with better tolerability and simpler dosing resulted in improved immunological and virological recovery and reduced incidences of switching due to toxicity and virological failure.
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College, Faculty of Medicine, London, United Kingdom.
authors.forename: Mikaela
authors.initials: M
authors.lastname: Smit
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.forename: Suzanne
authors.initials: S
authors.lastname: Geerlings
authors.forename: Luuk
authors.initials: L
authors.lastname: Gras
authors.forename: Kees
authors.initials: K
authors.lastname: Brinkman
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Hallett
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000266:history / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D044966:Anti-Retroviral Agents